Cervical erosion/ Cervical ectopy

Normally ,
 Definition
• It is a condition where Squamous epithelium
of ectocervix is replaced by columnar
epithelium, which is continuous with the
endocervix.
 Etiology
• Congenital
• Acquired

Congenital
• At birth, in 1/3rd of cases the columnar epithelium
of endocervix extends beyond the external os.
• Persists only for a few days until level of estrogen
derived from mother falls.
• Therefore congenital ectopy heals spontaneously.
Acquired

Hormonal
• The squamocolumnar junction (SCJ) is not static and its movement,
either inwards or outwards is dependent on estrogen.
• When the estrogen level is high, it moves out so that the columnar
epithelium extend into the vaginal portion of the cervix replacing the
squamous epithelium.
• This state is observed during pregnancy and amongst 'pill users'.
• The squamocolumnar junction returns back to its normal position
after 3 months following delivery and little earlier following
withdrawal of 'pill'.
Infection
• Chronic cervicitis may be associated.
 Clinical features
SYMPTOMS
• Vaginal Discharge – mucopurulent, offensive,
irritant in the presence of an infection. May
even be blood stained due to congestion.
• Contact bleeding specially during pregnancy
and 'pill use' either following coitus or
defecation may be associated.
• Associated cervicitis may produce backache,
pelvic pain and at times, infertility.
SIGNS :-
Internal examination reveals.
• P/S
– There is a bright red area surrounding and extending beyond the external
os in the ectocervix.
– The outer edge is clearly demarcated.
– It is neither tender nor bleeds to touch.
– On rubbing with a gauze piece, there may be multiple oozing spots.
• The feel is soft and granular giving rise to a grating sensation
 Differential Diagnosis
The diagnosis is confused with :
• Ectropion : The lips of cervix are curled back to
expose the endocervix. This may be apparent when the
lips of the cervix are stretched by the bivalve speculum.
• Early carcinoma : It is indurated, friable and usually
ulcerated which bleeds to touch. Confirmation is by
biopsy.
• Primary lesion : The ulcer has a punched - out
appearance.
• Tubercular ulcer : There is indurated ulcer with
caseation at the base. Biopsy confirms the diagnoses.
 Investigation
• Cervical smear
• Colposcopy
• Cervical biopsy
 Treatment
• All cases must be subjected to cytological
examination from cervical smear to exclude
dysplasia or malignancy
 Symptomatic cases
• If detected during pregnancy or early puerperal period -
Active treatment is postponed until 12months.

• If the patient is on oral contraceptives, it should be

stopped and the other barrier methods of contraception
should be advised.

• Persistent cervical erosion associated with disturbing

vaginal discharge should be treated surgically.
– Thermal cauterization
– Cryosurgery
– Laser vaporization